Gamma Knife Radiosurgery (GKRS) is now an established standard of treatment for the small-sized arteriovenous malformations (AVMs), meningiomas, schwannomas, metastasis, and other benign diseases. With an exponential rise in the indications for GKRS, we have witnessed an increase in the adverse radiation effects (ARE) following GKRS. The common AREs and associated risk factors following GKRS have been described for pathologies including vestibular schwannomas, arteriovenous malformations, meningiomas, and metastases based on the authors' experience, and a simplified management protocol has been provided for radiation-induced changes based on clinical and radiologic parameters. The dose, volume, location, and repeat stereotactic radiosurgery (SRS) are implied as the risk factors for ARE. Clinically symptomatic AREs require oral steroids for weeks to alleviate symptoms. In refractory cases, bevacizumab and surgical resection can be offered as a treatment modality. Appropriate dose planning strategy and hypofractionation for larger lesions help in mitigating the AREs.

中文翻译：

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伽玛刀放射外科手术后的不良辐射影响。

伽玛刀放射外科 (GKRS) 现在已成为治疗小型动静脉畸形 (AVM)、脑膜瘤、神经鞘瘤、转移瘤和其他良性疾病的既定标准。随着 GKRS 适应症呈指数级增长，我们目睹了 GKRS 后不良辐射效应 (ARE) 的增加。根据作者的经验，针对前庭神经鞘瘤、动静脉畸形、脑膜瘤和转移瘤等病理学描述了 GKRS 后的常见 ARE 和相关风险因素，并针对基于临床和放射学的辐射引起的变化提供了简化的管理方案参数。剂量、体积、位置和重复立体定向放射外科 (SRS) 被认为是 ARE 的危险因素。有临床症状的 ARE 需要口服类固醇数周才能缓解症状。在难治性病例中，可以提供贝伐珠单抗和手术切除作为治疗方式。适当的剂量计划策略和对较大病灶的大分割有助于减轻 ARE。